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Background: Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services. Aim: To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program. Methods: In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes. Results: Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication. Conclusions: Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery. [ABSTRACT FROM AUTHOR]

The article presents letter to the editor focuses on the use of twice-daily low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the right dorsolateral prefrontal cortex for treatment-resistant obsessive-compulsive disorder (OCD). Topics include the effectiveness of noninvasive brain stimulation techniques like TMS, a case study of a patient with severe OCD, and the potential benefits of accelerated TMS protocols for faster symptom relief and reduced treatment duration.

The article discusses the use of long-term repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD), highlighting two case studies of patients who maintained remission through extended rTMS therapy. Topics discussed include the effectiveness of maintenance rTMS, individualized treatment protocols, and the impact of comorbid conditions on therapy outcomes.

Background: The greatest contributor to the economic impact of common mental disorders (CMDs) is said to be the loss of work productivity. There is a paucity of studies from India that looks at the impact of CMDs on the productivity of work, which costs both patient and society significantly. Aim: To assess and compare work productivity by evaluating both absolute and relative presenteeism and absenteeism, in persons with CMDs. Materials and Methods: This was a cross-sectional observational study on 220 subjects (110, 58, and 52 patients with depressive disorder, anxiety disorders, and somatoform disorders, respectively), recruited through purposive sampling. We evaluated work productivity using the World Health Organization Health and Work Performance Questionnaire. Results: Absolute absenteeism was significantly different before and after treatment for CMDs as a group but not for individual disorders. Relative absenteeism, absolute presenteeism, and relative presenteeism were all significantly different before and after treatment among both CMDs as a group and also among individual disorders. Both presenteeism and absenteeism (absolute as well as relative) did not differ significantly across the diagnostic groups. Work productivity has been linearly associated with illness severity and disability. Conclusion: CMDs are associated with a significant loss of work productivity. Presenteeism is costlier than absenteeism in affecting work productivity. Loss of work productivity appears to be transdiagnostic across all CMDs. Also, the severity of loss of work productivity is associated linearly with the severity of illness and disability. [ABSTRACT FROM AUTHOR]

Objective: To generate the normative data of auditory P300 event-related potential for various age groups in the Indian population.Materials and Methods: Auditory P300 event-related potentials, using the oddball paradigm, of healthy control participants in studies carried out at our institute were included to generate normative data in the age range of 10-50 years. The amplitude and latency of P300 for Fz, Cz, and Pz were selected for analysis.Results: For P300 amplitude, overall multivariate analysis of variance (MANOVA) was significant [Pillai's Trace F (9/453) = 3.46, P < 0.001]. Follow-up ANOVA showed significant difference across age groups at Fz, Cz, and Pz. For P300 latency, there was a trend towards significance for overall MANOVA [Pillai's Trace F (9/453) = 1.68, P = 0.09]. Follow-up ANOVA showed a trend towards significant difference across age groups at Fz only.Conclusion: Our study generated a P300 amplitude and frequency normative database at Fz, Cz, and Pz, which will serve as a reference for future studies attempting to define P300 abnormalities in various psychiatric disorders in Indian population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding High Density Lipoprotein concentration during dependence states of alcoholism.

Background: Worldwide, common mental disorders (CMDs) (depression, anxiety, somatoform disorders) have a high prevalence in the community. About one-third of them experience disability. As the Indian Disability Evaluation and Assessment Scale (IDEAS) was originally designed by the Indian Psychiatric Society to assess disability in severe mental illnesses, it has not been widely used among CMDs. Our objective was to compare and establish a correlation between the level of disability obtained using IDEAS and the Sheehan Disability Scale (SDS) in CMDs., Methods: A cross-sectional assessment of disability was performed among 220 consenting patients with CMDs. Disability scores of IDEAS and SDS were compared and correlated across the three varieties of CMDs., Results: Age, gender, education, socioeconomic class, duration of illness, and duration of treatment exhibited significant differences among the three CMD groups. Both IDEAS and SDS show a milder level of disability; they did not differ significantly in their scores across CMDs. A strong correlation was seen between SDS and IDEAS across most domains., Conclusion: The study revealed strong concurrent validity between the two scales, thus advocating that indigenously designed IDEAS can convincingly assess disability across the CMDs among the Indian population., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© 2024 The Author(s).)

Competing Interests: SA is the Editor-in-Chief of the Indian Journal of Psychological Medicine. SKP, SA and VM serve on the editorial boards of several Indian psychiatry journals.

Adverse cutaneous reactions are frequently reported to occur with the use of psychotropic medications, which may lead to poor drug compliance. As compared to other groups of psychotropic medication, antipsychotics, both typical and atypical, are less likely to cause adverse cutaneous reactions. The most frequent cutaneous adverse reactions associated with antipsychotics include fixed drug eruptions, exanthematous eruptions, photosensitivity reactions and altered skin pigmentation. Most of these commonly seen cutaneous adverse reactions are benign and easily treatable. Rarely, severe cutaneous adverse reactions such as erythema multiforme, Steven-Johnson syndrome are toxic epidermal necrolysis and have also been associated with antipsychotics. Olanzapine is one of the most commonly prescribed atypical antipsychotic with metabolic complications as most common adverse effects. Dermatological reactions are rarely observed with olanzapine. We report occurrence of pellagroid skin lesions over exposed areas of upper limbs with olanzapine that resolved completely after its discontinuation.

Paroxetine is a commonly used antidepressant with a safe side-effect profile. A case of paroxetine overdose (560 mg) is reported in an 18-year-old female who attempted suicide and recovered without any sequelae, requiring only supportive treatment. This report highlights a case of pure paroxetine overdose and the safety profile of paroxetine in overdose.